Facility Evaluation Report

On 10/31/2025 at 8:10am, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with the Carmencita Co (Caregiver) and the purpose of today’s visit was explained. The facility is licensed to operate for (4) ambulatory, (1) non-ambulatory, (0) bedridden (developmentally disabled or Mentally Ill) adults ages 18 through 59. Currently, the home has (4) clients of which 3 of the clients are ambulatory and 1 of the clients is non-ambulatory. The clients are Harbor Regional Center clients. None the clients have Restricted Health Care Conditions and none are utilizing postural supports or protective devices.

The facility has a current administrator certificates (#7003054735) for Ronnel Agliam valid from 03/11/2024 - 03/10/2026 & Annabelle Agliam valid from 05/11/2024 - 05/10/2026. LPA provided the facility a copy of annual fees due on October 31, 2025 with a balance of 454.00 (PIN # 407359).

The facility is a one story home located in a residential neighborhood. The property consists of the following: 4 client bedrooms, 2 common bathrooms, staff room, living room, kitchen with a the washer and dryer setup, dining room, an outdoor shaded area and an attached garage with an additional refrigerator and bathroom.

Between the hours of 8:45am - 9:32am, LPA conducted a records review of (4) client records, (5) staff records, (4) clients Personal & Incidental Records and reviewed the facility disaster plan. All client & Staff records were complete. The facility disaster plan was current and in compliance with Title 22 at the time of visit. LPA reviewed (4) Client Medication Administration Records and did not observed any discrepancies at the time of visit. The last date on file for a fire drill being conducted is on 10/11/2025.